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Expert Opinion

Myelofibrosis-associated complications: pathogenesis, clinical manifestations, and effects on outcomes

, , &
Pages 89-101 | Published online: 29 Jan 2014
 

Abstract

Myelofibrosis (MF) is a rare chronic BCR-ABL1 (breakpoint cluster region-Abelson murine leukemia viral oncogene homologue 1)-negative myeloproliferative neoplasm characterized by progressive bone marrow fibrosis, inefficient hematopoiesis, and shortened survival. The clinical manifestations of MF include splenomegaly, consequent to extramedullary hematopoiesis, cytopenias, and an array of potentially debilitating abdominal and constitutional symptoms. Dysregulated Janus kinase (JAK)-signal transducer and activator of transcription signaling underlies secondary disease-associated effects in MF, such as myeloproliferation, bone marrow fibrosis, constitutional symptoms, and cachexia. Common fatal complications of MF include transformation to acute leukemia, thrombohemorrhagic events, organ failure, and infections. Potential complications from hepatosplenomegaly include portal hypertension and variceal bleeding, whereas extramedullary hematopoiesis outside the spleen and liver – depending on the affected organ – may result in intracranial hypertension, spinal cord compression, pulmonary hypertension, pleural effusions, lymphadenopathy, skin lesions, and/or exacerbation of abdominal symptoms. Although allogeneic stem cell transplantation is the only potentially curative therapy, it is suitable for few patients. The JAK1/JAK2 inhibitor ruxolitinib is effective in improving splenomegaly, MF-related symptoms, and quality-of-life measures. Emerging evidence that ruxolitinib may be associated with a survival benefit in intermediate- or high-risk MF suggests the possibility of a disease-modifying effect. Consequently, ruxolitinib could provide a treatment backbone to which other (conventional and novel) therapies may be added for the prevention and effective management of specific MF-associated complications.

Acknowledgments

Assistance with editing an advanced draft of the manuscript was provided by Roland Tacke, PhD, of Evidence Scientific Solutions, and funded by Incyte Corporation.

Disclosure

TIM consults for Incyte Corporation and is on the speakers’ bureau for Bristol-Myers Squibb. SV has received research support from Incyte, Bristol-Myers Squibb, AstraZeneca, NS Pharma, Roche, Celgene, Gilead, Infinity, Exelixis, YM Bioscience, S*Bio, Geron, and Lilly. NJS and KV are employees of Incyte Corporation.